title: Influence of abciximab on evolution of left ventricular function in patients with non-ST-segment elevation acute coronary syndromes undergoing PCI after clopidogrel pretreatment: lessons from the ISAR-REACT 2 trial.
abstract: BACKGROUND
  Abciximab reduced the combined endpoint of death, myocardial infarction (MI) and target vessel revascularization in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) undergoing percutaneous coronary intervention (PCI) with stent implantation after a 600-mg loading dose of clopidogrel. The aim of the present study was to investigate the impact of abciximab on the evolution of left ventricular ejection fraction (LVEF) in these patients.
  
  
  METHODS
  The current study included 1,158 patients enrolled in the randomized, double-blind ISAR-REACT 2 (the Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment) trial who had paired angiograms obtained at baseline and 6-8 months after randomization. Of them, 586 patients received abciximab and 572 patients received placebo. The primary outcome analysis was LVEF at 6-8-month follow-up.
  
  
  RESULTS
  Baseline LVEF was comparable in patients assigned to abciximab or placebo (53.2 ± 12.6 vs. 53.7 ± 12.1%; P = 0.393). At 6-8-month follow-up angiography, there was no difference in LVEF between the abciximab and placebo groups (55.4 ± 11.5 vs. 55.8 ± 11.2%; P = 0.743). Subgroup analysis of patients with elevated baseline troponin (>0.03 μg/L) also revealed comparable LVEF at follow-up in both treatment groups (P = 0.527). The multivariate analysis identified age, arterial hypertension, prior MI, prior coronary artery bypass graft surgery, baseline LVEF, MI at 30 days and repeat PCI as independent correlates of follow-up LVEF.
  
  
  CONCLUSIONS
  Although abciximab reduced the 30-day and 1-year incidence of major adverse cardiac events in patients with NSTE-ACS undergoing primary PCI after pre-treatment with a 600-mg loading dose of clopidogrel, the agent did not improve or impact on the evolution of LVEF over 6-8 months of follow-up.
authors.affiliation: Deutsches Herzzentrum, Technische Universität, Lazarettstr. 36, 80636, Munich, Germany. schulzs@dhm.mhn.de
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schulz
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.forename: Franz
authors.initials: F
authors.lastname: Dotzer
authors.forename: Michael
authors.initials: M
authors.lastname: Dommasch
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kufner
authors.forename: Kathrin A
authors.initials: KA
authors.lastname: Birkmeier
authors.forename: Klaus
authors.initials: K
authors.lastname: Tiroch
authors.forename: Robert A
authors.initials: RA
authors.lastname: Byrne
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
mesh_terms: D000077284:Abciximab; D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000503:physiopathology; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013318:Stroke Volume / Q000502:physiology*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D014336:Troponin; D000077144:Clopidogrel; D013988:Ticlopidine; D000077284:Abciximab